Note : Les descriptions sont présentées dans la langue officielle dans laquelle elles ont été soumises.
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1~
USE OF SIMETHICONE TO TREAT ULCERATIVE COLITIS
Field of the Invention
The present invention relates to a method of treating
s ulcerative colitis via the administration of an effective
amount of simethicone.
Hackaround of the Invention
Colitis is understood to be the inflammation of the
io colon. A chronic type of colitis is ulcerative colitis of an
unknown etiology characterized by ulceration of the colon and
rectum, with rectal bleeding, mucosal crypt abscesses,
inflammatory pseudopolyps, abdominal pain and diarrhea.
Ulcerative colitis frequently causes anemia, hypoproteinemia,
15 and electrolyte imbalance and is less frequently complicated
by peritonitis, toxic megacolon or carcinoma of the colon.
Ulcerative colitis is frequently treated with various
drugs including sulfasalazine. While these treatments are
somewhat effective in treating the symptoms, there is a
zo continuing need for additional treatments for this disease,
perhaps a treatment which could be used to enhance the
efficacy of the existing treatments.
Suaanary of the Invention
z5 The present invention provides a method of treating
ulcerative colitis in a patient through the administration of
an effective amount of simethicone. In a preferred
embodiment, an effective amount of a second active ingredient
for treating ulcerative colitis, such as sulfasalazine is
3o employed.
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Detailed Description of the Invention
Simethicone is a well known pharmaceutical material
which is a mixture of linear siloxane polymers containing
s repeating units of the formula {-Si0(CH3)z-)n stabilized with
trimethylsiloxy endblocking units of the formula [(CH3)3Si0-],
and silicon dioxide. The level of simethicone in the present
invention is sufficient to provide treatment of ulcerative
colitis. As used herein, treatment of ulcerative colitis is
io understood to be a reduction in the amount of bleeding in the
patient. The present invention contemplates the treatment of
a human or animal, through any suitable dosage forms.
Suitable forms includes solids, such as tablets or powders,
liquids including suspensions, dispersions and solutions and
15 the like. The preferred route of administration of the
simethicone is oral administration, although other techniques
known in the art may also be employed.
The effective level of simethicone is generally from
about 0.5 mg/kg of body weight per day to about 40 mg/kg of
2o body weight per day, preferably from about 1 mg/kg of body
weight per day to about 20 mg/kg of body weight per day, and
most preferably from about 5 mg/kg of body weight per day to
about 10 mg/kg of body weight per day.
The present invention can incorporate other known
2s pharmaceutically active ingredients for the treatment of
colitis. Specific groups of ingredients which may be used to
treat ulcerative colitis include immunosuppressive,
antimicrobial, antidiarrheal, and anticholinergic agents. Of
the immunosuppressive agents, sulfasalazine is preferred.
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Commonly known pharmaceutically acceptable additives
for orally-administered drugs such as sweeteners, flavoring
agents, dispersants, buffering agents and the like may be
included in amounts that do not adversely affect the novel
properties of the formulation described and claimed herein.
Suitable dispersants include methylcellulose,
hydroxymethyl-cellulose, hydroxypropylmethylcellulose,
hydroxyethyl-cellulose and the like. Suitable sweeteners
include sugar, sorbitol, saccharin, mannitol, glucose,
io aspartame and the like. Flavoring agents include
peppermint, spearmint, cinnamon, vanilla and the like. A
more complete listing of appropriate additives can be found
in numerous publications including Remington's Encyclopedia.
The present invention is surprising and unexpected in that
PCT EP95/00973 previously disclosed that
polydimethylsiloxane, also known as dimethicone, is effective
in association or affinity to the surface structure of the GI
tract. The PCT patent application continues that due to the
increased adhesion properties of dimethicone, the residence
2o time of an active ingredient in a region of the GI tract can
be substantially prolonged if dimethicone is used as a
transport or carrier system. This is contrary to the
disclosed invention in which simethicone, which as noted
above is a combination of polydimethylsiloxane and silicon
dioxide, is effective in being transported to the distal
regions of gastrointestinal tract.
The following examples are provided to further
illustrate the claimed invention, but not limit the invention
to the examples provided below.
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Example 1
This investigation used an experimental system in which
ulcerative colitis is induced in mice by incorporation of
dextran sulfate in the drinking water. For further detail,
see Okayasu, I., et al., Gastroenterology 98:694-702 (1990),
and Murthy, S., et al., Digestive Diseases and Science
38:1722-34 (1993). This experimental system has been used
previously for the evaluation of the efficacy of
pharmaceuticals compounds against ulcerative colitis. For
1o example, see Murthy et al., supra, and US Patent 5,869,048,
hereby incorporated by reference.
Female mice weighing between 26 and 33 grams were
segregated into five groups of fifteen mice per group. At the
beginning of the study the mice were allowed water ad
is libitum. After the initial acclimatization period, four
groups of mice were switched from water to 5~ weight dextran
sulfate solution (30,000 to 40,000 molecular weight, ICN
Biochemicals, Inc., Cosa Mesa, California) in order to induce
ulcerative colitis. The fifth group did not receive dextran
2o sulfate, but remained on water. The four groups of mice
received dextran sulfate solution for five days and then
returned to water for the remainder of the study.
The four groups of mice were then treated as follows: a
control was feed laboratory water; a second group received
2s sulfasalazine (400 mg/kg); a third group received simethicone
as a 30 percent emulsion (10 mg/kg); and the fourth group
received sulfasalazine and simethicone (400 mg/kg and 10
mg/kg). Dosing was performed by a single oral gavage on each
day of the treatment period, and the dose volume was 0.3 ml
3o per mouse. Sulfasalazine was purchased from Sigma Chemical
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Company (St. Louis, MO) and simethicone, in the form of a 30~
emulsion, was obtained from Dow-Corning (Midland, MI). The
dosing preparations were made fresh each day, and the dosing
preparations were used within one hour after preparation.
s Simethicone containing preparations were stirred continuously
to ensure homogeneity.
As expected, some mice died due to consequences of
severe colitis before the conclusion of the experiment. On
the eleventh day, including five days of treatment with
io dextran sulfate followed by five days treatment with the test
agent, measurement of colitis severity were obtained by
standard methods as follows.
Mice were examined for signs of diarrhea, stool
specimens were examined and tested for gross and occult blood
i5 (Hemoccult Strips SmithKline Diagnostics, San Jose,
California) and the mice were weighed and sacrificed. For
each mouse that survived the entire 10 day treatment, the
abdomen was opened, the colon removed and colon length from
cecum to rectum were measured. These colon measurements were
2o performed as an indication of the inflammatory changes
occurring in the colon during colitis and the severity of
colitis induced in the mouse. For each mouse, weight loss,
weight loss score, stool consistency score, stool blood score
and colon length (centimeters) were recorded. The disease
2s activity index (DAI) was calculated by addition of the weight
loss, stool consistency and stool blood scores. The criteria
for each are set forth below:
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Weictht Loss Condition Score
loss of less than a gram 0
loss of 1.0 to 5.0 grams 1
loss of 5.1 to 10.0 grams 2
loss of 10.1 to 15.0 grams 3
loss of more than 15 grams 4
Stool Consistency Condition Score
normal stool 0
loose stool 1
diarrhea 2
Stool blood Condition Score
normal stool 0
occult blood present 1
gross blood present 2
Among the mice treated with dextran sulfate and which
received no further treatment, the mortality was 67~ (10 of
15). The mice treated with sulfasalazine, simethicone and
the combination of sulfasalazine and simethicone had a much
lower mortality rate, 40, 47 and 40 percent respectively.
Sulfasalazine produced improvement in all measures of
colitis severity. Compared to respective control values,
weight loss was less (10.4 +/- 3.6 percent), scores for
diarrhea, bloody stool and DAI were less (scores 0.8+/- 0.2,
0.6+/- 0.2; and 3.4 +/- 0.8 respectively) and colon
shortening was less (10.3 +/- 0.5 centimeters). The
improvements in percent weight loss (61 percent), DAI (53
3o percent) and colon shortening (29 percent) were statistically
significant, p less than 0.05.
Simethicone produced improvements in all measures of
colitis severity except weight loss. Compared to control,
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weight loss was nearly the same (25.7% (sem +/- 4.1 percent),
scores for diarrhea, bloody stool and DAI was less (1.0 +/-0,
0.8 +/- 0.3 and 5.5 +/- 0.4 respectively) and colon
shortening was less (8.6 +/- 0.3 centimeters). The greatest
s improvement was in the score for bloody stools; bleeding was
reduced by 38 percent.
The combination of sulfasalazine and simethicone
produced moderate to large improvement in all measures of
colitis severity. Compared to respective control values,
io weight loss was less (13.6%; sem +/- 2.3 percent), scores for
diarrhea, bloody stools and DAI were less 0.9 +/- 0.1, 0.2
+/- 0.2, and 4.1 +/- 0.4, respectively) and colon shortening
was less (colon length 9.6 +/- 0.2 centimeters). The
improvements in percent weight loss (49%), bloody stools and
15 colon shortening (20%) were statistically significant, p less
than 0.05. The greatest improvement was in the score for
bloody stools, bleeding was almost completely suppressed (83
percent), an effect much greater than that produced by either
sulfasalazine or simethicone alone.
2o The above results indicate that simethicone at a low
dosage of about 10 mg/kg is effective in the treatment of
ulcerative colitis and the combination of sulfasalazine and
simethicone is unexpectedly very effective.
